| NPI | 1740465657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 244093) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 244093) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2025-10-29 |